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Original Article
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Volume 353:1673-1684 October 20, 2005 Number 16
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Trastuzumab plus Adjuvant Chemotherapy for Operable HER2-Positive Breast Cancer
Edward H. Romond, M.D., Edith A. Perez, M.D., John Bryant, Ph.D., Vera J. Suman, Ph.D., Charles E. Geyer, Jr., M.D., Nancy E. Davidson, M.D., Elizabeth Tan-Chiu, M.D., Silvana Martino, D.O., Soonmyung Paik, M.D., Peter A. Kaufman, M.D., Sandra M. Swain, M.D., Thomas M. Pisansky, M.D., Louis Fehrenbacher, M.D., Leila A. Kutteh, M.D., Victor G. Vogel, M.D., Daniel W. Visscher, M.D., Greg Yothers, Ph.D., Robert B. Jenkins, M.D., Ph.D., Ann M. Brown, Sc.D., Shaker R. Dakhil, M.D., Eleftherios P. Mamounas, M.D., M.P.H., Wilma L. Lingle, Ph.D., Pamela M. Klein, M.D., James N. Ingle, M.D., and Norman Wolmark, M.D.

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ABSTRACT

Background We present the combined results of two trials that compared adjuvant chemotherapy with or without concurrent trastuzumab in women with surgically removed HER2-positive breast cancer.

Methods The National Surgical Adjuvant Breast and Bowel Project trial B-31 compared doxorubicin and cyclophosphamide followed by paclitaxel every 3 weeks (group 1) with the same regimen plus 52 weeks of trastuzumab beginning with the first dose of paclitaxel (group 2). The North Central Cancer Treatment Group trial N9831 compared three regimens: doxorubicin and cyclophosphamide followed by weekly paclitaxel (group A), the same regimen followed by 52 weeks of trastuzumab after paclitaxel (group B), and the same regimen plus 52 weeks of trastuzumab initiated concomitantly with paclitaxel (group C). The studies were amended to include a joint analysis comparing groups 1 and A (the control group) with groups 2 and C (the trastuzumab group). Group B was excluded because trastuzumab was not given concurrently with paclitaxel.

Results By March 15, 2005, 394 events (recurrent, second primary cancer, or death before recurrence) had been reported, triggering the first scheduled interim analysis. Of these, 133 were in the trastuzumab group and 261 in the control group (hazard ratio, 0.48; P<0.0001). This result crossed the early stopping boundary. The absolute difference in disease-free survival between the trastuzumab group and the control group was 12 percent at three years. Trastuzumab therapy was associated with a 33 percent reduction in the risk of death (P=0.015). The three-year cumulative incidence of class III or IV congestive heart failure or death from cardiac causes in the trastuzumab group was 4.1 percent in trial B-31 and 2.9 percent in trial N9831.

Conclusions Trastuzumab combined with paclitaxel after doxorubicin and cyclophosphamide improves outcomes among women with surgically removed HER2-positive breast cancer. (ClinicalTrials.gov numbers, NCT00004067 [ClinicalTrials.gov] and NCT00005970 [ClinicalTrials.gov] .)


Source Information

From the National Surgical Adjuvant Breast and Bowel Project, Pittsburgh (E.H.R., J.B., C.E.G., E.T.-C., S.P., S.M.S., L.F., V.G.V., G.Y., A.M.B., E.P.M., N.W.); University of Kentucky, Lexington (E.H.R.); North Central Cancer Treatment Group, Rochester, Minn. (E.A.P., V.J.S., T.M.P., L.A.K., D.W.V., R.B.J., S.R.D., W.L.L., J.N.I.); Mayo Clinic Jacksonville, Jacksonville, Fla. (E.A.P.); University of Pittsburgh, Pittsburgh (J.B., G.Y.); Mayo Clinic, Rochester, Minn. (V.J.S., T.M.P., D.W.V., R.B.J., W.L.L., J.N.I.); Allegheny General Hospital, Pittsburgh (C.E.G., N.W.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (N.E.D.), the Cancer Research Network, Plantation, Fla. (E.T.-C.); Angeles Clinic and Research Institute, Santa Monica, Calif. (S.M.); Norris Cotton Cancer Center, Dartmouth–Hitchcock Medical Center, Lebanon, N.H. (P.A.K.); Cancer Therapeutics Branch, National Cancer Institute, Bethesda, Md. (S.M.S.); Kaiser Permanente Medical Center Northern California, Vallejo (L.F.); Oncology Associates of Cedar Rapids, Cedar Rapids, Iowa (L.A.K.); University of Pittsburgh Cancer Institute, Pittsburgh (V.G.V.); Wichita Community Clinical Oncology Program, Wichita, Kans. (S.R.D.); Aultman Health Foundation, Canton, Ohio (E.P.M.); and Genentech, South San Francisco, Calif. (P.M.K.).

Drs. Romond and Perez contributed equally to the article.

Address reprint requests to Dr. Geyer at the Allegheny Cancer Center, 5th Fl., 320 E. North Ave., Pittsburgh, PA 15212, or at cgeyer{at}wpahs.org.

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Related Letters:

Trastuzumab in Breast Cancer
Gilbert S. G., Banna G. L., Santoro A., Gounaris I. G., Katsumata M., Drebin J. A., Greene M. I., Mastrianni D. M., Mano M., Cameron D., Gelber R. D., the HERA Trial Study Team , Bryant J., Romond E., Perez E. A., Hortobagyi G. N., Barron H.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:640-644, Feb 9, 2006. Correspondence

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